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July 17, 2012

Back to Diabetes Basics – Part 10

Insulins

No, I did not leave this for near the
last because it is the treatment of last resort for most doctors. I
wanted to do my research and leave this series with what I feel is a
great topic that needs attention. And, being near the last topic,
you may remember more about it.

We know that people with type 1
diabetes can't live without insulin, but the medical community
(especially the American Diabetes Association (ADA)) seems to think
that people with type 2 diabetes can. In this light, they promote
oral medications and if the first one they prescribe does not take
care of the problem, they keep stacking oral medications. They will
not prescribe insulin until they deplete the oral medications or have
no other choice. I say they are causing more harm with this method
of treatment than they doing patients good. From the preceding blog,
you can see some of the side effects caused by oral medications.

That is not to say that insulin has no
side effects, as insulins can. Some people are allergic to the
insulins not produced by their own body, and for them insulin can be
very toxic. Fortunately, their number is small and sometimes can be
overcome with the right introduction and treatment regimen. For an
even smaller number some insulins (not analogue insulins) approved
and still on the market outside the USA will work for them. The
remaining people will never be able to tolerate insulin that they do
not produce in their own bodies.

For many years, the insulin used by
people with diabetes was produced from the pancreases of pigs and
cows. Synthetic human insulin derived from genetically engineered
bacteria first became available in the 1980s, and now all insulin
available in the United States is manufactured in a laboratory.
Although the development of synthetic human insulin was a boon for
most people, especially those who were allergic to the animal
insulins, a few people find that they can manage their diabetes
better using animal insulins.

Although animal insulins are no longer
produced in the United States, the FDA allows individuals to import
animal insulins for their own personal use. See their Policy on
Importation of Drugs (1998) for more information. The Insulin
Dependent Diabetes Trust, a nonprofit group in the United Kingdom,
has additional information on animal insulins, including contact
information for a company in the U.K. that still manufactures them. Explore the site if you need more information.

The major side effect of insulin can be
a dangerously low blood sugar level (severe hypoglycemia). A very low
blood sugar level can develop within 10 to 15 minutes with
rapid-acting insulins. Always have glucose tablets, 6 oz or 8 oz
juice drinks, or other suitable fast acting carbohydrates available to treat
hypoglycemia. Glucose tablets are the fastest acting and most
reliable.

Insulin can contribute to weight gain,
especially in people with type 2 diabetes who already are overweight.
The myth about weight gain on insulin happens to be fact, although
in reality it is muddied up by people. For people with type 2
diabetes, taking insulin can cause weight gain. There are several
reasons for this. The one factor that comes to the front is people
use insulin as the medication of last resort. Normally this is
fought until there is no longer any choice, insulin cannot be
postponed as blood glucose levels are out of control and oral
medications cannot keep blood glucose levels down.

Because insulin is often the medication
of last resort, two factors can cause weight gain. The first is
inactivity or sedentary lifestyle. This may be caused by diabetic
neuropathy, which makes it difficult to walk more than short
distances. The second is people do not reduce the intake of
carbohydrates when going on insulin.

Why is the second necessary? Because
insulin is necessary, when first started, insulin makes management of
blood glucose levels easier. Instead of losing some of your
carbohydrates in your urine when your blood glucose exceeded your
urinary limits, these carbohydrates are now put to work or stored as
fat. This new efficiency in blood glucose management generally
causes initial weight gain.

This is the main reason that people
starting on insulin should consider reducing the total carbohydrate
intake for a period of time while your body adjusts to the
efficiency. However, if you are a person that is able to exercise on
a regular basis and you do this, your carbohydrate intake may not
need to be reduced greatly and may be resumed shortly after starting
insulin.

Weight gain is always a possibility for
some body types and these people must learn to manage their
carbohydrate intake to avoid weight gain. The article did say that
you should limit your insulin dosage, which is only possible, if you
reduce your intake of carbohydrates. I will also reemphasize their
statement of using exercise to aid in insulin use to burn calories
and help keep insulin use low. This will aid in preventing weight
gain.

Other possible side effects of
long-term insulin use include the loss of fatty tissue
(lipodystrophy) where the insulin is injected and, in rare cases,
allergic reactions that include swelling, or edema.

What can affect insulin? Some factors
that affect how fast and how well an insulin dose works are:

Where the dose is given. If you
give insulin into your abdomen (especially above and to the side of
your belly button), the medicine will get into your system more
consistently from day to day. If the medicine is given into a muscle
or a small blood vessel instead of fatty tissue, the medicine will
get into your system faster. This is generally not recommended by
most doctors.

How much insulin is given.
Higher doses of insulin reduce the blood sugar level more than lower
doses. Do not overdose!

Whether you have exercised
before or just after taking insulin. If you have just exercised the
muscles in the area where you give your insulin injection, the
medicine will get into your system faster.

If you apply heat to the area.
The medicine will get into your system faster if you take a hot bath
or shower, put on a heat pack, or massage the area where you have
just given your insulin injection.

If you do not drink enough
water and you are dehydrated, you will not have as much blood flow to
your skin, so insulin will not be absorbed as well as it would be
otherwise.

Things to do

Label each insulin bottle when
it is used for the first time, and discard unused medicine after 30
days. A bottle of insulin may lose its potency after 30 days of use.
Most inserts accompanying your insulin will state 28 days.

Store insulin properly so that
its effectiveness is protected. Storing it in the refrigerator is
the ideal place, but preferably not in the door to avoid vibrations
when the refrigerator door is opened and closed.

When you buy insulin, check the
generic or brand names to make sure you are buying the correct type.
For example, if you have been using Humulin-R (insulin regular), make
sure you buy Humulin-R instead of Humulin-N (insulin NPH).

Know when your prescribed types
of insulin start working (onset), when they work most (peak), and how
long they work (duration).

Know how to give an insulin
injection.

Once you have started using the
vial of insulin, it generally is not necessary to return it to the
refrigerator. Only return it to the refrigerator if the temperature
in the house or apartment will be above 85 degrees Fahrenheit for an
extended period of time as this will shorten the life of the insulin
or make it unusable.

Keep insulin out of direct
sunlight and in Frio packs or a cooler with cold packs if it is in a
vehicle for any length of time or while traveling or hiking.

The Internet does have some good tips
here and if you search, you may find more.

One word of encouragement you should
take away is that a move to insulin does not mean you have failed
in your diabetes management. Just the fact that you are reading this
should mean that you are doing you homework and learning about
insulin. True, most doctors use insulin as the medication of last
resort and this should not be the rule. Once one or two of the oral
medications have not worked, instead of letting your doctor stack on
more oral medications, give insulin serious consideration.

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About Me

I am enjoying life, despite diabetes type 2. I am retired and enjoying the time I have for writing and photography. I was diagnosed with type 2 on Oct 2003, on oral meds for 4 months and they were doing nothing to really improve my daily readings. By cutting my carbohydrates I received the most improvement, but still not enough. Then I requested insulin, even though I did not like the thought of needles. That brought about the biggest change and A1c's in the lower 6's and upper 5's. Now I am working at maintaining them under 6.0 and hopefully nearer 5.5.